Why treating diabetes keeps getting more expensive • Hacker News Board

Re: Why treating diabetes keeps getting more expensive

#41

Post by shadowtree » Tue, Jan 23, 2018, 1:34 PM UTC

pja wrote: post #39

marvin wrote: post #35

Earlier quoted context omitted.

I always thought that when patents expire, a generics company will duplicate the drug (or treatment mechanism) and the prices will plummet to close to marginal cost due to competition. I get the impression that this happens in Europe, given the generic options that I am encouraged to choose when I’m picking up a prescription at the pharmacy. They are invariably cheaper. What is different for diabetes, or the United S…

Generics still require FDA approval, which costs on the order of single digit $millions to obtain. Plus you’ve got to set up the plant to create the drug, which costs more $. Would you invest $millions in a product when a competitor (who probably already has plant capacity from when they made the drug while it was under patent) could come in and undercut you at a moments notice? Obviously not - so the system ends up…

Only true for rare and ultra-rare diseases.

Re: Why treating diabetes keeps getting more expensive

#42

Post by Kayou » Tue, Jan 23, 2018, 1:38 PM UTC

theorique wrote: post #32

Kayou wrote: post #22

Earlier quoted context omitted.

You still need to have carbs in your diet, it wouldn't be healthy otherwise. Especially if you practice a sport. I eat whatever I want (mostly pasta usually) and I need 20 units a day at most. (100 units/ml dosage).

There's no dietary or metabolic need for carbohydrate. The human body can survive and thrive perfectly well with only fat and protein as macronutrients. Practically speaking, doing that is challenging and complicated because most foods are a mix of all three macronutrients.

But do you need sugar? Or you don't need either sugar nor carbs? It seems strange to me. EDIT: it seems that if you use only your fat, you'll end up producing too much Ketones which leads to Ketoacidosis. Doesn't sound good.

Re: Why treating diabetes keeps getting more expensive

#43

Post by rbultje » Tue, Jan 23, 2018, 1:38 PM UTC

marvin wrote: post #35

rbultje wrote: post #33

“I don’t think it takes a cynic such as myself to see most of these drugs are being developed to preserve patent protection,” said David Nathan, a Harvard Medical School professor. “The truth is they are marginally different, and the clinical benefits of them over the older drugs have been zero.” -- quote from article And there you have it. I have seen this myself. One year ago, the insulin I was on was removed from…

I always thought that when patents expire, a generics company will duplicate the drug (or treatment mechanism) and the prices will plummet to close to marginal cost due to competition. I get the impression that this happens in Europe, given the generic options that I am encouraged to choose when I’m picking up a prescription at the pharmacy. They are invariably cheaper. What is different for diabetes, or the United S…

Don't forget that switching insulin is not easy. You have to adjust and refine the amounts you take for several days or even weeks, while closely monitoring your blood sugar during that period. It's stressful and unpleasant. Here, you are forced to do that once (one year before the patent runs out) and it sucks. Why do it twice? If the insurance company covers the new insulin anyway?

But the insurance company masks the real price. All our insurance policies are getting more expensive and cover less because we are all paying for it, together. We all know it, but we all take the easy way out. Including me. You are right, it is deeply unethical.

Europeans more often think holistically about health care (and its cost), which is a good thing. In the US, health care (and its cost) is primarily driven by corporations whose primary goal is profits and shareholder value. They are not aligned.

Re: Why treating diabetes keeps getting more expensive

#44

Post by bobzibub » Tue, Jan 23, 2018, 1:52 PM UTC

loverofthings wrote: post #15

michaelmrose wrote: post #8

Earlier quoted context omitted.

Demand has gone up it hasn't risen exponentially. The manufacturers have colluded to raise the price. There is no reason for it to ever come down.

We live in the age of globalization and capitalism. There's bunch of cheap stuff coming from all over the world. Collusion on that scale is not possible. There's just more people suffering from diabetes T2 than ever before. Someone is just profiting off of large demand.

I would refine "globalism and capitalism" to just "corporatism". It really is socialism for companies and capitalism for you and I. Patent laws suit big Pharma. Trade law and health guidelines suit big Agriculture. (Ketoer here so you know where I'm coming from.) Tough luck for the millions of people caught in the middle between these influential sets of oligarchs. It is abhorrent that regular people subsidize (and pay a high price in life and limb) for government's covert largess to these corporations.

Re: Why treating diabetes keeps getting more expensive

#45

Post by mizzack » Tue, Jan 23, 2018, 1:54 PM UTC

Kayou wrote: post #42

theorique wrote: post #32

Earlier quoted context omitted.

There's no dietary or metabolic need for carbohydrate. The human body can survive and thrive perfectly well with only fat and protein as macronutrients. Practically speaking, doing that is challenging and complicated because most foods are a mix of all three macronutrients.

But do you need sugar? Or you don't need either sugar nor carbs? It seems strange to me. EDIT: it seems that if you use only your fat, you'll end up producing too much Ketones which leads to Ketoacidosis. Doesn't sound good.

No, ketosis doesn't lead to ketoacidosis unless you completely neglect to manage your insulin.

Re: Why treating diabetes keeps getting more expensive

#46

Post by maxerickson » Tue, Jan 23, 2018, 1:56 PM UTC

marvin wrote: post #35

rbultje wrote: post #33

“I don’t think it takes a cynic such as myself to see most of these drugs are being developed to preserve patent protection,” said David Nathan, a Harvard Medical School professor. “The truth is they are marginally different, and the clinical benefits of them over the older drugs have been zero.” -- quote from article And there you have it. I have seen this myself. One year ago, the insulin I was on was removed from…

I always thought that when patents expire, a generics company will duplicate the drug (or treatment mechanism) and the prices will plummet to close to marginal cost due to competition. I get the impression that this happens in Europe, given the generic options that I am encouraged to choose when I’m picking up a prescription at the pharmacy. They are invariably cheaper. What is different for diabetes, or the United S…

Many generics in the US do cost around $5 a month or less.

For some drugs, the manufacturers work the system, withdrawing their previous version from the market and launching a new version with some tweak. Withdrawing the old version makes it more difficult for someone else to get permission to manufacture and sell it.

The basic problem is that (the majority of) the engaged, wealthy part of the country gets their insurance from someone else and doesn't give a shit about how much medical stuff costs. And we have a medical system where the primary regulatory impact on prices is from capture.

Re: Why treating diabetes keeps getting more expensive

#47

Post by nugi » Tue, Jan 23, 2018, 2:15 PM UTC

Kayou wrote: post #22

bruxis wrote: post #21

Earlier quoted context omitted.

Just to add a bit of a positive spin on this: even type-1 diabetics could take measures to both improve their health and reduce the amount of insulin they require. I consider myself moderately overweight at this point (maybe 10-15kg). If I lost weight, I could reduce the baseline amount of insulin I need every day, thus reducing the amount of insulin overall that I need to pay for. I also fully acknowledge that, upon…

You still need to have carbs in your diet, it wouldn't be healthy otherwise. Especially if you practice a sport. I eat whatever I want (mostly pasta usually) and I need 20 units a day at most. (100 units/ml dosage).

This is patently untrue.

Re: Why treating diabetes keeps getting more expensive

#48

Post by nugi » Tue, Jan 23, 2018, 2:16 PM UTC

Kayou wrote: post #42

theorique wrote: post #32

Earlier quoted context omitted.

There's no dietary or metabolic need for carbohydrate. The human body can survive and thrive perfectly well with only fat and protein as macronutrients. Practically speaking, doing that is challenging and complicated because most foods are a mix of all three macronutrients.

But do you need sugar? Or you don't need either sugar nor carbs? It seems strange to me. EDIT: it seems that if you use only your fat, you'll end up producing too much Ketones which leads to Ketoacidosis. Doesn't sound good.

Ketosis is perfectly healthy. You are very confused.

Re: Why treating diabetes keeps getting more expensive

#49

Post by thousandautumns » Tue, Jan 23, 2018, 3:14 PM UTC

kakoni wrote: post #16

Whats up with those US prices, Humalog more than $250 per vial? In Europe (Finland) non-subsidized price is $34.

As others have stated, pricing and insurance in the US is a complete rats nest. There are rebates and discount card programs available to the vast majority of patients that mean that most patients are paying much much less than that.

Re: Why treating diabetes keeps getting more expensive

#50

Post by thousandautumns » Tue, Jan 23, 2018, 3:17 PM UTC

Angostura wrote: post #12

Interesting, the response in the UK has been to address this by attempting to pump money into programmes to to try and prevent type 2 diabetes or at least reduce its growth. Still too early to see how these efforts will be.

That should be the response everywhere. The soaring cost of diabetes is largely tied to the soaring numbers of Type 2 diabetics, and the treatments are really just alleviating symptoms, and aren't actual cures. The only way to tackle the problem is to get (Type 2) diabetics to lose weight. Though this is obviously easier said than done.